Not a Creature was Stirring

Not a Creature Was Stirring

“Not a creature was stirring, not even a mouse . . . 1

As we settle into winter, exercise has become more of a challenge not only because of holiday activities and savory treats but also the shortened days and colder weather. Meanwhile our bodies struggle to adapt to all the extra food, the reduction in sunlight and endorphins.  But research is offering a solution: treadmill exercise.

A Japanese study looking at the effect of treadmill exercise on cognitive decline and white matter found that mice who used the treadmill for six weeks had decreased cognitive decline and increased white matter compared to the mice who were sedentary.2

If you are dealing with behavioral disturbances related to an Alzheimer’s diagnosis, consider the research findings on physical exercise mitigating behavioral impairments.3 Also a mouse study, this study looked at the role of voluntary physical activity with a level of endurance in lessening behaviors. Mice who did the voluntary physical activity had a decrease in behaviors. Could it be that walking while watching a favorite movie or listening to a preferred playlist provide the endurance for the treadmill? Although the research has started with mice, let’s not hold off on reaping the benefits.

Human subject research looking at exercise’s impact on our brains, shows equally encouraging results for individuals diagnosed with Mild Cognitive Impairment.4 This study looked at the combined impact of physical and cognitive exercise. Weekly 90-minute sessions for 40 weeks showed the group receiving combined cognitive and physical exercise improved or maintained their cognitive status compared to the control group that received a 90-minute health promotion class.

As we settle into our winter routines, let’s avoid playing the role of mouse in The Night Before Christmas but instead be modern mice—mice committed to improving our brains by walking, using the treadmill and strengthening cognition with audio books, podcasts, or favorite movies.

Footnotes

1Moore, C.C., The Random House Book of Poetry for Children (Random House Inc., 1983.

2 Ohtomo, R., Kinoshita, K., Ohtomo, G., Takase, H., Hamanaka, G. et al., (2019).  Treadmill exercise suppresses cognitive decline and increases white matter Oligodendrocyte precursor cells in a mouse model of prolonged cerebral hypoperfusion, Translational Stroke Research, Oct. 12. Doi:10.1007.                             

3Bernardo, T.C., Beleza, J.Rizo-Roca, D.Santos-Alves, E,. Leal, C., et al. (2019). Physical exercise mitigates behavioral impairments in a rat model of sporadic Alzheimer’s disease, Behavioral Brain Research, Nov. 13: 112358.

4Shimada H1Makizako H2Doi T2Park H3Tsutsumimoto K2, et al., (2018).  Effects of combined physical and cognitive exercises on cognition and mobility in patients with Mild Cognitive Impairment: A randomized clinical trial, Journal of American Medical Director’s Association, 19(7): 584-591.

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Light in the Darkness

Light in the Darkness

Regardless of faith, tradition, or background—winter’s darkness calls for increased light. If you have lived with dementia for any amount of time, you feel the darkness at a different level—wishing for light. A common behavioral manifestation for an individual with dementia is night-time wakefulness.  Usually accompanied by agitation, this behavior leaves dementia caregivers overtired and overwhelmed.

Research shows that season and weather significantly affect nocturnal rest for the individual with dementia.1 In this study, the researchers defined nocturnal rest as the five consecutive hours with the least motor activity during a 24-hour day.  Using this criterion, the study showed the most predictable variable of activity.  The findings were that day length and cloud amount were associated with night-time activity. Specifically, nursing home residents with dementia were more active at night on cloudy short days than on clear short days. The researchers concluded that adding extra internal lighting to the shorter and cloudier days could be an anecdote to the night-time wakefulness.2

Research has shown there is much more to the sleep-wake cycle of an individual with Alzheimer’s than weather and day length.  Circadian rhythm, the natural internal process regulating sleep-wake cycle, has been shown to have a bi-directional interaction. Sleep disruption actually influences the cognitive decline in Alzheimer’s disease as Alzheimer’s disease influences the individual’s circadian rhythm.3 The use of melatonin and bright light therapy are suggested as anecdotes to help the sleep-wake cycle.

For centuries, cultures far and wide have worked to increase light in the dark days of winter.  As you enter winter as a dementia caregiver, consider ways to brighten the darkness with bright light and décor reminiscent of the season. Embrace the warmth and light of the fireplace, the light of no-flame candles, and the treats that bring you light. They just might bring you sleep.

Footnotes

1Wahnschaffe, A.,  Nowozin, C., Rath, A.Floessner, T., et al. (2017). Night-time activity forecast by season and weather in a longitudinal design – natural light effects on three years’ rest-activity cycles in nursing home residents with dementia, International Psychogeriatrics, 29(12): 2071-2080.

2Mitolo, M., Tonon, C., La Morgia, C., Testa, C., Carelli, V., et al. (2018).  Effects of light treatment on sleep, cognition, mood, and behavior in Alzheimer’s Disease: A systematic review, Dementia & Geriatric Cognitive Disorders, 46(5-6): 371-384.

3 Saeed, Y., Abbott, S.M. (2017). Circadian disruption associated with Alzheimer’s Disease, Current Neurology & Neuroscience Report, 17(4): 29.

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Dementia Abundance

Those two words seem discordant at first glance. Once we have a diagnosis or at least medical recognition of memory changes, we have reality confirmed.  The signs we have been seeing are no longer in our imagination.  Reality stills any allusions you might have that your life will return to normal. Abundance you once had has turned to scarcity. 

As Thanksgiving approaches, the theme of gratitude is prevalent.  We think back to holidays past, and savor the memories but find it hard to feel grateful for the present.  Our loved ones may not be able to tolerate the traditions once held.  Our caregiving demands may be depleting our physical and spiritual strength.

Research has shown an increase in well-being by practicing gratitude, regardless of circumstances.1 It has been suggested that listing a few things you are grateful for can reduce depression and increase resilience.  Well-being and resilience are commodities well worth pursuing as a dementia caregiver.

Equally positive in research is reminiscence.  Even though dementia has changed your relationship with your loved one, reminiscing on sweet times can help lighten the scarcity today. Re-looking at photos or visualizing a time when you were happy together can add abundance to a day.

As you see cornucopias symbolizing abundance and a plentiful harvest, consider your care cornucopia. This is a symbolic basket  of your care strategies and tools. 

Is your care cornucopia full? 

  • Do you have family or friends who support you when you are frustrated or overwhelmed?
  • What ways are you able to get away to take care of your own self-care needs? 
  • Are there support groups or memory cafes that provide you and your loved one with safety and perspective?
  • Do you have a daily and weekly routine?

Perhaps you have these in place. If not, this would be a good season to add some strategy either through asking for help from family or friends or contracting with an agency or provider. 

Harvest baskets and cornucopias are not only full but diverse in color and texture. 

Is your care cornucopia colorful?

  • Does your weekly routine include some derivation of an activity that both you and your loved one have always enjoyed?
  • Are you getting daily physical exercise? 
  • Are you getting weekly socialization?
  • Do you have activities that give you a sense of purpose?

As we enter the harvest season, keep in mind that the farmer’s harvest season was one of preserving what is plentiful for the darker and colder days of winter.

 As we give care to individuals with progressive neurodegenerative disease, today’s harvest must last through darker colder days. But do not fret–your care cornucopia can be added to at any time—resources are abundant.

Whether it is a call to a friend, reading an Alzheimer’s-specific book, calling your local Arden Courts, accessing an online support network—you can increase your care harvest for both you and your loved one.

Footnotes

1Wood, A. M., Froh, J.J. & Geraghty, A. W. A. (2010).  Gratitude and well-being: A review, Clinical Psychology Review, 30: 890-905.

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Exercise as a Gift to Yourself

Exercise as a Gift to Yourself

As the days get shorter, you may find your desire to do physical exercise is decreasing as well. Folks have coined Oct 31-Jan 2 as the eating season. So we have less sunlight to encourage exercise, more intake of calories and an uptick on homemade coziness–a trifecta that is known to affect both mental and physical health. 

Why not look at exercise as a gift to yourself?  A gift that is given long before the gift-giving season, but that will make that season more enjoyable and you healthier.  Change is in the air, so perhaps you decide to try an online video that you have seen or a new class at the local community center.  It might be dancing, or tai chi or join the Silver Sneakers group. 

Research shows that those of us living with early dementia have perceived facilitators and barriers to exercise.1 This qualitative study revealed three themes that were barriers and influencers. The individual with early dementia reported low intrinsic motivation and an overall non-fit of resources to their needs and preferences. The care partner used poor physical/cognitive health and transportation as influential motivators. But motivation may be in short supply . . .

Caregivers— did you know that research is showing exercise as a great non-pharmacological intervention for improving global and specific cognitive function?  In a review of research conducted in nursing homes, it was found that exercise in combination with cognitive training and activities of daily living played a significant role in improving cognitive function.2 The research quantified the amount of exercise as 30 minutes a day.  Within 8 weeks of combined intervention.  Considering this is nursing home research, it is likely that those improvements were in folks who were in moderate to later stages.

Maybe 30 minutes seems like a long time.  Consider ways to up the amount of physical exercise by:

  • Parking the car further from the store
  • Taking the steps instead of the elevator
  • Walking the dog one more block or one more time
  • Dancing to a few songs on the radio

We may not be at the stage of life to take on a marathon training program, but we would benefit from upping our physical activity game. Always with a doctor weighing in on your choices. Once your physician agrees to your plan, start with a low number of minutes and slowly build up to what has been medically approved as an ideal goal.

Consider it as a gift to yourself and to your loved one—your brain and body will be grateful.

Footnotes

1Hobson, N., Dupuis, S.L., Giangregorio, L. M., & Middleton, L. E. (2019).  Perceived facilitators and barriers to exercise among older adults with Mild Cognitive Impairment and early dementia, Journal of Aging & Physical Activity, 24:1-11.

2Yorozuya, K., Kubo, Y., Tomiyama, N., Yamane, S., & Hanaoka, H. (2019). A systematic review of multimodal non-pharmacological interventions for cognitive function in older people with dementia in nursing homes, Dementia and Geriatric Cognitive Disorders, 21:1-16.

By

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Mushroom or Grape?

Many of you know me as the sunny good time, put-a-spin-on-it dementia gal. But trust me, I can be as overwhelmed with the diagnosis, or
vaguaries there of, as the next person. I benefit from showing up like the sun, even when I do not feel sunny. This journey is not for the weak.

I will be addressing the “Dark Side of Dementia” this Weds, Oct 23 at
Arden Courts of Seminole. This seminar will give you with real strategies that can help shine light on the fading of our husbands, our parents or
our friends.As a Gerontologist, I am unique in that I bring not only 40+
years of experience working with individuals with dementia and their
families, but because I have worked within the many systems our society has to support the journey. From companion, home health, nurse’s aide,
skilled nursing, assisted living, memory care, and adult day—I have a
breadth of knowledge and comfort that I can share with you.And then
there are the degrees–a Master’s in Death and Dying from Hood College, and a PhD in Aging Studies from USF.

Today I count my vineyard as full because of the opportunities provided
for me to share my knowledge through Arden Courts this Weds.I am
totally psyched about the Harvesting Memories workshop that will
provide caregivers with a fun and encouraging morning of creativity and engagement. I am happily creating the first CATE holiday engagement
book that is free to attendees.

All because of the generosity of our sponsors: Anderson McQueen, Assisting Hands, Prudential, Touching Hearts, Arden Courts, Fusion Health,
Griswold Homecare, and Care Patrol.Memory friends and family–our
vineyard of resources is full—but can only stay full with your
participation.

Please RSVP and attend the Shining Light seminar, the Harvesting
Memories workshop and our memory cafes—do not hide like a
mushroom in the dark—come out into the light so that we can share our
struggles as well as our joys.Even the bitterest of grapes can make a
palatable jelly.

So much sweeter than a mushroom grown in the dark.
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Pets and Quality of Life

With so many forms of dementia—it is increasingly difficult for caregivers to provide quality of life as their loved ones enter the final stages of brain change. Strategies that once worked, no longer do. Research shows a consensus on what caregivers’ value for their loved one at end-of-life:

  • family involvement
  • living in the present
  •  pragmatic expectations
  • autonomy and individuality1

Yet family involvement often diminishes as the loved one declines; expectations are often not realistic, and autonomy limited due to physical and cognitive changes. 

Several studies found that individuals in later stage dementia were positively affected by animal-assisted interventions.2 In a study comparing nursing home residents who received a 30-minute session twice a week with a companion-trained dog had significantly lower depression scores than the control group. The dog group showed a significant increase on quality of life ratings also. 

Companion pets have been shown to not only impact the individual with dementia’s mental health but also physical health.3 Studies showed companion pets were associated with marked increases in physical activity and improvements in blood pressure and heart rate variability.

If orchestrating a trained dog visit or having a companion pet is not feasible, consider a robotic pet.  A meta-analysis of numerous studies showed use of a robotic pet with people with dementia was associated with a significant decline in behaviors and psychological symptoms of dementia including depression.4  Robotic pets are available on-line with a price range manageable for most budgets.

As your loved one moves into the final stage of brain decline, comfort can come in the form of a pet to touch and cuddle; often providing the whole family with a sense of well-being.

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Fall In Florida

A recent meme beautifully stated “trees are God’s way of showing us that good things can come from letting go.” Our Florida falls are less about surrender and more about preparation. Though I think the two work in synergy. Coming off of Dorian’s energies, I realized how little I had prepared for fall in Florida. We had just changed RV’s , trading engine for size. Meaning we would not be able to hit the road with our home. I was in MD. We had not provisioned. We had no evac plans though in an A zone for evacuation. Mike was prepping, but we were worried . . . The provisioning I had was the bevy of professionals who were committed to the survival and security of Mike and I. I had my team in place.

Having a diagnosis of dementia, is like living life in the path of a hurricane. There are predictable changes that will affect our home, our security and our relationship. Short of another diagnosis overtaking dementia’s path, there will be categorical change. Like hurricane season, a dementia diagnosis will require both preparation and surrender.

Preparation means education, consultation and training. Dr. Cate Dementia Coach will

  • Calm your fears and provide expert coaching on preparation
  • Train you to adapt to dementia changes
  • Provide the best strategies and resources to thrive despite the diagnosis

Realizing you need help means letting go of your fear:

  • Fear that others will know (they already do);
  • Fear that you will be unable to afford help
  • Fear of knowing the truth of dementia’s path

If you are living with dementia either as an individual or a caregiver, start preparation–call or email Dr. Cate as a first step in being ahead of the categorical changes ahead.

MIke

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Not There Yet

This is a common refrain. A caregiver asks Dr. Cate for dementia guidance. I answer a specific question and then outline strategic plans they may want to consider. The response is always “We are not there yet.”

The question to ask yourself is “where is there?” When your relationship is enough overwhelmed with brain change to ask for help—where are you? As a caregiver myself, I hear myself saying “not there yet”. This is an answer that comes from my desire to be anywhere but here—and my fear of there. It is my fear of financial struggle, and my fear of needing to adapt even more than I already have. But fear will keep me stuck in an increasingly difficult reality. And stuck for a caregiver leads to failing self-care; failing health and, in over 60% of Alzheimer’s caregivers, death.

So let’s not go there. Let’s open ourselves to solutions that are offered now even if we are not sure we need them yet. In over 40 years of experience, I have never seen anyone get help before they needed it.

This disease is progressive and unrelenting. Instead what I have seen is those who were “not there yet” are suddenly in a crisis with few options. The crisis inevitably leads to reactive decisions that are regretted.

Let Dr. Cate be your go-to for more than the one quick question. Come to Dr. Cate for the game plan development; the team building; and the on-the-job training that will minimize the crises and the reactive decisions. Then when you are there, I guarantee a much bigger scrapbook of positive memories and far fewer regrets.

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Objectivity & Perspective

This month has been a big month for me because I was challenged to practice what I preach. I needed objectivity for Mike, something I have none of, simply because I desire for him what may not always be in his best interest. A looming neurology apptmnt and my business coach’s reading of my last blog . . . . congealed into reaching out to a trusted professional whom Mike adores. The day of his apptmnt with his “au pair” as he calls her was both freeing for me and worrisome. I enjoyed my marketing calls without worry of rushing back to rush to the tension of yet another fruitless neurologist appointment.

I had provided a detailed list of what I wanted tested, answered, etc. I was hopeful. Until I was almost home, then I felt like it had been his first day at school–how did it go? What would I walk into?

But I parked a block from home and connected with our care manager. She gave a glowing report. She had accomplished what would have taken me another two years to accomplish.

Why??

She is a highly trained, highly observant, and highly objective professional. Mike did not fight her on each question, refute her statements. Instead he bantered, he probably flirted, and he was assessed and observed by the neurologist for a full two hours. A record in our experience. Next steps are in place for driving, for neuropsych, for MRI. That night he diligently started taking the medicine he had fought me about for the last month. Compliance. When I asked him how it went, he was quite pleased with the apptmnt, best yet. And the “au pair”, well over the moon.

When it comes to our loved one, we are unable to be objective no matter what degree, experience or commitment we possess. Our loved ones can divert, mislead and charm the neurologist, the neuropsychologist, the nurse. Our caregiving stress becomes the dominant take-home for the doctor. We can leave frustrated and empty-handed.

This walk of Dr Cate is one of honor and humility. I am honored to be the trusted and objective dementia coach for individuals and families. I am humbled to be on this path with my spouse.

My care team is expanding, and will continue to expand–because I know that a strong coach and a strong team can pull us through the toughest times.

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Who?

As a business owner, a woman, an individual, a mother, a caregiver—sometimes I forget who I am. I have found the anecdote is daily time in nature, practicing mindfulness. The beauty of this is I am gentle enough with myself to allow this to not include a certain place, pose or structure. This morning’s church was at Lee’s Travel Park pool. By myself, with the company of a mockingbird. Back floating, water-bugging, floating and watching this fella belt out one tune after another. A repertoire fit for a king or queen.
Perhaps he was waiting for a drink, or maybe simply bng present in nature–doing his job, singing his heart out. Caregivers often lose track of who they are. Our lives seem overtaken by the alien dementia that inhabits the loves of our lives. But a mockingbird can bring you back to yourself. Song can bring you back to yourself. Take time to listen for your Who.

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